title: Observations on the effects of inhaled isoflurane in long-term sedation of critically Ill children using a modified AnaConDa©-system.
abstract: Long-term intravenous sedation may present problems due to dependence and side effects. Medical records of children who were administered isoflurane were reviewed. 15 patients (9 boys, 6 girls) with a mean age of 11.8 month (+2.4) were analysed.Analgesia and sedation was given in mean 9.7+1.1 days before commencing inhalation using a modified application device (AnaConDa©). Administration was given over a period of 7.2+1.4 days. Depth of sedation was monitored by using Comfort- and Hartwig-scores. Observations included continuous monitoring of heart-rate, pulse oxymetry, blood pressure and cerebral tissue oxygenation.Within 4 h post administration of isoflurane a satisfactory increase in the depth of sedation was seen and kept till extubation. 6/15 patients received tracheostomies during the observation period. None of the patients observed suffered life-critical events of the modified application of isoflurane proceeded without complications. Ketamine and clonidine infusion rates were significantly reduced (p<0.005) as well as the use and overall infusion rate of midazolam, γ-hydroxy butyrate, fentanyl and morphine (p<0.05).Isoflurane inhalation may provide an additional option for long-term sedation in a specific group of critically ill infants but neurodegenerative toxic effects will have to be taken into account when using volatile anesthetics at any time during infancy.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Cologne, Germany. frank.eifi nger@uk-koeln.de
authors.forename: F
authors.initials: F
authors.lastname: Eifinger
authors.forename: C
authors.initials: C
authors.lastname: Hünseler
authors.forename: B
authors.initials: B
authors.lastname: Roth
authors.forename: A
authors.initials: A
authors.lastname: Vierzig
authors.forename: A
authors.initials: A
authors.lastname: Oberthuer
authors.forename: K
authors.initials: K
authors.lastname: Mehler
authors.forename: A
authors.initials: A
authors.lastname: Kribs
authors.forename: C
authors.initials: C
authors.lastname: Menzel
authors.forename: U
authors.initials: U
authors.lastname: Trieschmann
mesh_terms: D000769:Anesthesia, Inhalation / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007530:Isoflurane / Q000009:adverse effects; D008134:Long-Term Care; D008297:Male; D009410:Nerve Degeneration / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors; D014140:Tracheotomy
chemical_list: D007530:Isoflurane